Four surgical options for weight loss

When it gets tough to treat obesity through exercise or diet alone, bariatric surgical options come to the patients' rescue. From placing a small pouch in the tummy that makes one feel fuller soon to having a narrow tube-like stomach, there are new solutions that doctors can do today.

Did you know that 12% of Indian urban population and 2% of rural population is obese? An average Indian man should weigh around 62-64 kg and woman should be around 54-56 kg. Obesity is on the rise and not surprisingly, obesity treatments are on the rise.

Obesity is usually referred to in terms of BMI (Body Mass Index). We consider obesity surgery in people with BMI of 37 or more and in BMI of 32 or more with associated co morbidities said above. Obesity surgery can be considered for women who exceed 90 kg and in men exceeding 100 kg as their BMI would be very high.

The current surgical options for morbid obesity are:

1. Laparoscopic adjustable Gastric band placement

In this operation, a silicone gastric band is placed around the upper part of the stomach, creating a small pouch. The small size of the pouch means that you feel full sooner. The band can be adjusted in size by inflating or deflating the band. This allows the health professional to adjust the size of the opening between the pouch and the stomach and in turn can effectively control amount of food required to obtain early satiety. Gastric band procedure is the simplest and safest of all weight loss procedures and yields similar weight loss compared to all other procedures over a course of three years.

2.Laparoscopic Gastric Sleeve resection

Approximately 85% of stomach is removed during this surgery leaving a narrow tube like stomach. Due to very small capacity of the tubular stomach, less food can be consumed and early satiety achieved. This procedure is irreversible and is relatively new with data of efficacy for past three years. Good weight loss is witnessed with this procedure. However, concern exists regarding the possibility of re-enlargement of the stomach tube. This should not result if the appropriate diet guidelines are followed.

3. Laparoscopic Roux-en-y Gastric Bypass

This procedure combines the restrictive factor by reducing the amount of food can be consumed and adds the component of mal-absorption by re-routing the small intestine. This procedure till date is considered as the ‘gold standard’ among weight loss procedures. It involves creation of gastric pouch which is completely separated from the rest of the stomach and is re-attached to small intestine. There is another additional attachment (Anastamosis) between two loops of small intestine to facilitate the flow of food material.

Due to the component of mal-absorption, some may experience deficiency in vitamins, calcium, iron etc. These components can be supplemented successfully to avoid such issues.

4. Laparoscopic Bilio-Pancreatic diversion +/- duodenal switch

This is probably the most evolved procedure currently available for weight loss. It includes removal of a portion of stomach and re-routing the small intestine to reduce the food absorption and results in weight loss.There are procedures such as Duodeno- jejunal bypass, ileal transposition +/- Gastric sleeve resection, etc. Regardless of the procedure performed, the efficacy of these surgical procedures is unquestionable. There is significant improvement in quality of life after such surgeries.

The results of bariatric surgery are good with 60-75% weight loss over a period of 12 to 18 months and more importantly resolution of co-morbidities.